New member looking for Oscar data help

[mttm]

Hi all I'm a new member here and was looking for some help with Oscar data I started recording, but I'll give some details quickly first. 

For a little over a year now I've been feeling fatigued and had a feeling of brain fog. I've went through my PCP to rule things out by taking MRI, EEG, blood test for iron, vitamin B, thyroid conditions, lyme disease etc. but everything came back normal. I took two at home tests through Lofta and Wesper where I they recorded AHIs of 14.0 and 5.7 respectively. 

I was recently able to get a ResMed AirSense 11 device and an SD card for it which I have been recording data on. The online RX written for me prescribed pressure 4-20 but I have since changed it to most recently 8-20. 

I am able to sleep pretty well with the device and have no trouble falling/staying asleep. I understand that it can take a while for changes to be felt but I was wondering if I actually even have sleep apnea in the first place or if it is just long covid or something else entirely. 

Some of my questions were, is there any way to tell if I actually have sleep apnea from this data? Should I make any changes to my CPAP settings at the moment based on the data and why? What types of things should I be monitoring when using my machine? When would one want to use APAP or constant pressure?

I have attached my OSCAR images below as well as a public SleepHQ link here: https://sleephq.com/public/teams/share_links/3b72d0b1-df5c-4619-b134-6dafa709fe65/dashboard?from_date=2024-09-28&machine_id=YLVAmj. Thank you all in advance for any help and I'm happy to answer any questions  

[staceyburke]

Min 8 looked better than min 7. You are close to being dialed in BB you could raise the min a little mor. Try 8.6 and take a look at your pressure chart and see if it is fairly flat. Flatter is better BUT how you feel is the most important.

[coutherino]

Hello, welcome. I suppose I'll start by answering your questions and then talking about what I found in your data.

Some of my questions were, is there any way to tell if I actually have sleep apnea from this data?

Yes, you will be. Your CPAP tracks every breath you take during the night in something called the flow rate graph. By looking for drops and subsequent spikes in your flow rate, you can determine if you're having apneas.

Should I make any changes to my CPAP settings at the moment based on the data and why?

Probably. I'll get to that in a moment, though.

What types of things should I be monitoring when using my machine?

Mainly your leak and flow rate data. These are by far and away the most important graphs. Leak can be detrimental to your sleep, both because leak can undermine the effectiveness of your therapy, and it's ability to keep your airway stable throughout the night. But also because leak itself can be incredibly disruptive towards sleep, if there is enough of it, and it is highly variable. Flow rate tells you everything about your breathing, and since this is, at it's core, a respiratory disorder, it is the most important. You mainly want to look out for decreases in airflow that precede an arousal, or a spike in the flow rate graph. It's not the decrease in airflow itself that disturbs sleep, but the subsequent awakening that usually follows them.

When would one want to use APAP or constant pressure?

I... struggle to recommend APAP for any circumstance. It is an inherently flawed system, as it works reactively instead of proactively. Meaning it only does something AFTER you've already briefly woken up. It falsely flags events, it misses events, it over titrates and under titrates constantly. It is merely the machine's interpretation of your flow rate graph, and it is not infallible. A constant pressure works because your anatomy does not change. The only variables here are potential weight loss/gain, and sleeping position changes, which can both affect how obstructed your airway becomes. But beyond that, once you find the right pressure, it will stabilize your airway throughout the entire night.

As for your data, the main thing that stands out to me is leak. It is absolutely disturbing your sleep. I can give some specific examples next post as to why if you're curious. You're using a nasal mask, so it appears to be a mouth leak, which is when your tongue and face muscles relax during sleep, allowing the air to shoot out through your mouth. If you've been experiencing any dry mouth this is why. This is definitely something you're going to want to fix, and really the only way you can is with mouth tape. You asked if there was any way you could tell if you had sleep apnea. Below, I attached three examples of hypopneas from one night (none of which your machine even tagged lol, hence my thoughts on APAP) which is typically defined by at least a 30% decrease in airflow, followed by an arousal.

   

   

   

My main recommendation would be to eliminate leak. If you're not comfortable using mouth tape under any circumstance, maybe it would be beneficial to look into a full face mask. But managing leak is typically much easier with a nasal mask once you solve for mouth leak, which is an easy fix. As for pressure settings... I'd recommend starting at a fixed pressure of 10 cmH2O. You might need to be lower, you might need to be higher. I won't be able to tell until I can see a night with it. But with that much leak it can really muddle the data, so fixing that is definitely what I'd recommend doing first.

Apologies for the incredibly long response, but I hope this helps.

[mttm]

Thank you both for all of the help and details. I decided to switch to the CPAP mode at a pressure of 10. It was a little difficult for me to fall asleep but I know I'll be able to get used to it because I've used mouth tape and upped my pressure in the past so it will likely just take a few days. I think I did wake up a few times and I did take the mouth tape off at some point, but as I said I will just get used to this with time. No apologies needed for the long post haha it was extremely helpful. I've posted my OSCAR result of last night below and the SleepHQ link is the same as before: https://sleephq.com/public/teams/share_l..._id=YLVAmj. Any comments on this most recent night of data would be greatly appreciated, thanks

[coutherino]

I guess you saw the part at the end of my post about setting the N20 to pillows. I edited that out a few minutes afterwards, but you actually had it on the right setting. I always forget the N20 is supposed to be on pillows, that's my bad.

Your breathing looks surprisingly good on 10 cm, at least during periods of low, non-variable leak. For the most part, your breaths look round and full, except for a few periods. Do you typically sleep on your side or back, or do you switch between the two?

I didn't catch any true hypopneas like before, untagged or otherwise. But I didn't scroll through the entire night, so there could be something I missed. The main thing is leak, leak, leak. It will help so much if you're able to get rid of it entirely, not only in helping you feel more rested, but with being able to look at your data and figure out if you're for sure on the right pressure. Below, I posted screenshots comparing your breathing between two periods. In one, the leak is constant, but low and not erratic. In the other, the leak is still low(ish), but very erratic with multiple spikes. Look at how stable your breathing is in the first image compared to the second one. All those little spikes you see are very likely periods where you're briefly waking up, though you probably don't remember it. That's nearly an hour of disturbed sleep just right there. I'm not sure what mouth tape you're currently using, but I highly recommend "Cover-Roll Stretch" tape. You can find it on Amazon, and it's quite cheap.

   

   

[mttm]

That sounds good I'll change the setting back to pillows. I typically sleep on my back most of the time but on occasion I'll roll onto my side, should I try to sleep one way in particular? That's interesting about the leak thanks for explaining that with the images too. I'll look into getting that mouth tape you recommended too. For tonight I'll keep the pressure settings the same and post those results tomorrow, hopefully I'm able to sleep a little better because I'm a little more used to it.

[coutherino]

I'd try to pick one position and stick with it. For most people they have it worse on their back and require more pressure. I don't know about Wesper but in Lofta's report it should have a break down of your AHI/RDI based on your position. If it's significantly worse supine sleeping on your side could be something to think about, but you'd probably have to stop sleeping on your back entirely if you choose to do that. You're already on a pretty low pressure and without leak your breathing looks quite good at 10, and I assume for some of that you're likely on your back. So you should probably just do what's most comfortable for now. Hope it goes well tonight!

[mttm]

Last night didn't feel great, I think early on I ended up taking the mouth tape off. I woke up sometime later and went to put tape back on so that's where that gap comes from. I woke up at the end with the tape still so I assume it worked from then on. Here is the SleepHQ link with updated data: https://sleephq.com/public/teams/share_links/3b72d0b1-df5c-4619-b134-6dafa709fe65/dashboard. I made a post on a DME-owned forum initially and I put the Wesper and Lofta data here: https://www. a DME-owned forum .com/viewtopic/t188788/New-member-with-a-couple-questions.html?sid=ce6b40bda321b0550c764aeabeeb1688. I'm not sure if there's anything else I can change at this point besides just getting used to this setup so I'll post the next night's tomorrow, any advice is appreciated as always

[coutherino]

Your leak was... definitely pretty bad last night. Just looking at the data, I'm not surprised it didn't feel great. It was actually pretty good before the tape came off, but it did not get better afterwards, even after you put it back on, which I assume is when you turned the CPAP off for a few minutes around 12:30. Just out of curiously, what tape are you currently using?

Your leak should essentially be 0 for the entire night, like the first image. Your leak graph last night is the second image. A few spikes here and there are normal as you change positions and the mask momentarily slips, but this level of leak is detrimental to your sleep. Do you think any of this might be your mask leaking? Have you ever woken up to it blowing air out the sides? It looks like mouth leak, but if you said the tape was still on after you replaced it during the night, it makes me question things.

   

   

I looked at your Lofta and Wesper reports too. Lofta's was kind of ambiguous with whether you were worse on your back or not in my opinion, but on Wesper's report that seemed to be the case. Anyways, I hate to sound like a broken record but none of this really matters until you fix the leak. You will sleep so much better once you do.

[Phaleronic]

Hello mttm, welcome to the forum

I do not know who this new guy is, and how he's a preferred member already, but he does have a little bit of good advice  I'd turn EPR down to 1 tonight, it will help with OA events that I just zoomed in on in your sleephq chart, and you're also regain the apneacontrol you've been missing, your leak rate at 10cm is 16.8 so you're under the threshold.